NUR445 Critical Care Exam 1

This problem can be encountered in critical care. Inability to secrete ADH in response to an Osmotic Stimuli or Non-stimuli. Inappropriate dilute urine. Can be Congenital or Acquired from Neurosurgery, head trauma, tumors, increased brain death. Infections such as Encephalitis & Meningitis. Is it: a. Nephrogenic DI b. Central DI (neurogenic)

b. Central DI (neurogenic)

HHS is most often see in: a. Type 1 diabetes b. Type 2 diabetes

b. Type 2 diabetes Hyperglycemic Hyperosmolar State is seen in Type II Diabetes

This test can be done at the bedside. It is used to aspirate tissue or remove obstructive secretions. The patient should remain NPO 6-8 hrs afterwards. A topical anesthetic or sedative is given to the patient. What test is it? a. ABG b. Thoracentesis c. CXR d. Bronchoscopy

d. Bronchoscopy Bronchoscopy Safe, can be done at bedside, used to aspirate tissue or remove obstructive secretions. NPO 6-8 hours afterwards. Topical anesthetic or sedative is given. Diazepams, Opioids, or Atropine to decrease secretions. Decrease vagal response.

What should a fasting blood glucose be?

70-100mg/dL

What is a normal anion gap range?

8-16 mEq/L

What is a normal A1C for a non-diabetic?

< 5.4-5.6%

What is a normal A1C for a diabetic?

< 6.5%

What is a Low Anion Gap? What does this represent?

< 8 is low It indicates Metabolic Alkalosis

What is a High Anion Gap? What does this represent?

> 18 is high It indicates metabolic acidosis. It effects over production or decreased exertion of acid products

Islets of Langerhans is groups of pancreatic cells secreting insulin and glucagon from the pancreas. What are the names of the cells?

Alpha Cells Beta Cells Delta Cells PP Cells

T/F Respiratory distress is where the patient may be unable to answer questions. Only say a few words, have limited conversation.

True Respiratory Distress The patient may be unable to answer questions. Only able to say a few words, limited conversations.

What do PP cells secrete? a. pancreatic polypeptide b. insulin c. glucagon d. somatostatin

a. pancreatic polypeptide

The following are complications of DKA: (SATA) a. dehydration b. fluid overload c. hypernatremia d. hyponatremia e. ventricular fibrillation f. atrial fibrillation g. hypoglycemia h. hyperglycemia

b. fluid overload d. hyponatremia e. ventricular fibrillation g. hypoglycemia Surveillance of Complications FLUID OVERLOAD HYPOGLYCEMIA- BGL <70mg/dL HYPERKALEMIA/HYPOKALEMIA- TALL PEAKED WAVES (ECG/CARDIAC MONITORING) → V-FIB HYPONATREMIA Abdominal cramping, Postural hypotension, Unexpected Behavioral changes (HEADACHE, CONFUSED, INFECTION). The patient is at RISK FOR CEREBRAL EDEMA

The process of of free fatty acids being metabolized into ketones is called: a. Gluconogenesis b. Ketonesis c. Gluconeogenesis d. Neurogenic neogenesis

c. Gluconeogenesis

Diabetic Ketacidosis (DKA) is more often seen in: a. Type 2 Diabetes b. Cushing's Syndrome c. Type 1 Diabetes d. Myxedema

c. Type 1 Diabetes These patients are insulin dependent - they don't produce insulin

A patient walks into the ER. They have abdominal pain, Kussmaul respirations, an altered LOC, polydipsia, polyphagia, polyuria, vomiting, thready pulse, acetone breath, and their pulse is thready and tachycardic. What do you suspect they have? a. HHS b. SIADH c. DI d. DKA

d. DKA These are classic s/s of DKA

Which organ is involved in Glucose metabolism? a. stomach b. liver c. intestines d. pancreas

d. pancreas The pancreas is involved in Glucose Metabolism

What do delta cells secrete? a. pancreatic polypeptide b. insulin c. glucagon d. somatostatin

d. somatostatin Somatostatin (decrease glucagon & insulin)

What does the anion gap represent? a. represents the measurable amount of ions present in the extracellular fluid b. represents the unmeasurable ions present in ht extracellular fluid c. represents the measurable of ions present in the intracellular fluid d. represents the unmeasurable of ions present in the intracellular fluid

b. represents the unmeasurable ions present in ht extracellular fluid

What diagnostic criteria is needed to consider someone having DKA? a. hypoglycemia b. extremely high levels of plasma glucose w/ resulting elevations of serum osmolality causing osmostic diuresis c. hyperglycemia d. extremely low levels of plasma glucose w/ resulting dip of serum osmolality causing osmostic retention

c. hyperglycemia

T/F Pressures less than 25 mmHg (30 cm H2O) should be reported to the physician

False Pressures in excess of 25 mm Hg (30 cm H2O) should be reported to the physician.

Keytones in the urine indicate what? a. dehydration b. infection c. hyperglycemia d. renal damage

c. hyperglycemia Ketones in the urine could indicate hyperglycemia & poorly controlled diabetes. Glucose can't be transported into the cells because of lack of insulin. Fats are broken down and used for energy. Ketones are a by-product of fat breakdown. Ketones leak into the urine.

T/F With an endotracheal tube, the cuff pressure should be maintained at 24 to 30 mm Hg (20-25 cm H2O).

False Cuff pressures should be maintained at 20 to 25 mm Hg (24 to 30 cm H2O)

T/F It is common to deflate cuffs whenever the patient needs to be repositioned.

False Cuffs are not routinely deflated because this increases the risk of aspiration.

T/F Hypoxemia can be minimized by giving the patient five hyperoxygenation breaths (breaths at 50% FiO2) with the ventilator before the procedure begins and again after each pass of the suction catheter.

False Hypoxemia can be minimized by giving the patient three hyperoxygenation breaths (breaths at 100% FiO2) with the ventilator before the procedure begins and again after each pass of the suction catheter

Glycated Hemoglobin A1C measures blood glucose for how many months?

It checks the blood glucose for the past 3-4 months (120 days)

What should a postprandial blood glucose be?

It should not exceed 180mg/dL

What type of fluids should be given to a patient who has DKA? a. hypertonic 3% b. hypotonic 0.45 NS c. isotonic 0.9% sodium chloride d. isotonic D5W

c. isotonic 0.9% sodium chloride This is to reverse the dehydration. They may need 6-9L of fluid. Once their blood glucose level falls to 200mg/dL - then switch to Dextrose 5% (D5W) with 0.45% Hypotonic NS. Then start to transition the pt to SQ insulin.

T/F Endotracheal tube is known as an artificial airway?

True

T/F When doing nursing management for Oxygen, the two most important things to worry about are: 1) ensuring the oxygen is being administered as ordered 2) observing for complications of the therapy

True

T/F Greater cuff pressure in an endotracheal tube will decrease the blood flow to the capillaries in the tracheal wall and lesser pressures increase the risk of aspiration.

True Cuff pressures should be maintained at 20 to 25 mm Hg (24 to 30 cm H2O) because greater pressures decrease blood flow to the capillaries in the tracheal wall and lesser pressures increase the risk of aspiration.

The nurse is caring for a client with Cushing's syndrome. The nurse knows that this disease is caused by hypersecretion of which of the following hormones? Select all that apply. a. Aldosterone b. Cortisol c. Testosterone d. Follicle-stimulating hormone e. Adrenocorticotropic hormone

a. Aldosterone Aldosterone, which is the hormone responsible for the secretion of sodium and water from the body, is one of the hormones that is hypersecreted in Cushing's syndrome. b. Cortisol Cortisol secreted in excess leads to Cushing's syndrome. c. Testosterone Testosterone, an androgen, is excessively secreted in a client with Cushing's syndrome, along with cortisol and aldosterone. e. Adrenocorticotropic hormone This hormone, also known as ACTH, is often hypersecreted in the client with Cushing's syndrome. d. Follicle-stimulating hormone This hormone is secreted by the pituitary gland, and while Cushing's can be caused by a pituitary tumor, excess FSH is not related to Cushing's syndrome.

A client who has been diagnosed with diabetes insipidus has been prescribed vasopressin as an antidiuretic replacement. The nurse caring for the client reviews his other medications. Which drug should not be taken with vasopressin? a. Carbamazepine b. Levothyroxine c. Omeprazole d. Diphenhydramine

a. Carbamazepine Vasopressin is a medication that has the effects of anti-diuretic hormone. It can be used to control blood pressure and is used for the treatment of diabetes insipidus. Vasopressin should not be used with carbamazepine, as carbamazepine can decrease the overall effects of vasopressin in the bloodstream. b. Levothyroxine This drug does not have any known interactions with vasopressin. c. Omeprazole This drug does not have any known interactions with vasopressin. d. Diphenhydramine This drug does not have any known interactions with vasopressin.

A client is suffering from excess cortisol excretion as a result of an adenoma on the pituitary gland. Which of the following changes is an expected finding in a client with this condition? Select all that apply. a. Fatty tissue deposits in the face and upper back b. Skin that bruises easily c. Swelling in the neck and throat d. Increase in the number of stretch marks e. Lesions on the peripheral extremities

a. Fatty tissue deposits in the face and upper back Cortisol is a stress hormone secreted from the adrenal glands near the kidneys. Excess cortisol production can cause a number of changes associated with different body systems., including obesity and fatty tissue deposits on the face and upper back. b. Skin that bruises easily Excess cortisol leads to easily bruised skin. This is a common symptom of Cushing's syndrome. d. Increase in the number of stretch marks Skin changes that may be seen with excess cortisol include purple stretch marks (striae), easy bruising, weight gain, fatty tissue deposits in the midsection, upper back and face, excess body hair in women, and decreased fertility in men. c. Swelling in the neck and throat Fatty deposits can occur in the face from excess cortisol secretion, but this is different from swelling. Swelling in the neck and throat would indicate an emergency situation and require immediate medical attention. e. Lesions on the peripheral extremities Excess cortisol secretion does not cause lesions.

The nurse is caring for a client who is starting a long-term regimen of glucocorticoids for adrenal insufficiency. Which of the following teaching points is appropriate for the nurse to include when educating the client on this medication? Select all that apply. a. Glucocorticoids should be used carefully if diabetes mellitus is present b. The client should monitor for weight gain and edema c. Hyperglycemia is a side effect of glucocorticoids d. Glucocorticoids decrease the risk of osteoporosis e. Glucocorticoids mask the signs of infection

a. Glucocorticoids should be used carefully if diabetes mellitus is present These contribute to hyperglycemia & therefore worsen blood glucose levels. b. The client should monitor for weight gain and edema Weight gain & edema are common side effects for glucocorticoid use. c. Hyperglycemia is a side effect of glucocorticoids Glucocorticoids affect glucose metabolism which causes hyperglycemia d. Glucocorticoids decrease the risk of osteoporosis These medications increase the risk of osteoporosis e. Glucocorticoids mask the signs of infection Glucocorticoids suppress the immune system & produce anti-inflammatory effects

A nurse should be most concerned about which of the following assessment findings? a. High pitched stridorous breath sounds b. Coarse crackles with cough and shortness of breath c. Asthma attack with wheezing d. Use of rescue inhaler every day

a. High pitched stridorous breath sounds All of these clients are having airway and breathing problems but anyone with stridor is experiencing an obstructed upper airway. This could be potentially from the airway closing, or something stuck in the airway, either way it is emergent and should be the most concerning finding. b. Coarse crackles with cough and shortness of breath This is an issue, likely fluid building up in the lungs. It needs to be addressed and evaluated. However, stridor indicates airway obstruction, which is of higher concern than crackles at this time. c. Asthma attack with wheezing This client is a concern, and should be evaluated. However, an obstructed upper airway is most concerning because it can cause a life-threatening situation much faster. d. Use of rescue inhaler every day This client is not the highest priority, but this finding should alert the nurse that the client's asthma may not be well controlled. This should be discussed with the provider.

A nurse is caring for a client who has been diagnosed with syndrome of inappropriate anti-diuretic hormone (SIADH). What type of electrolyte imbalance would the nurse most likely see in this situation? a. Hyponatremia b. Hyperkalemia c. Hypocalcemia d. Hypermagnesemia

a. Hyponatremia Syndrome of inappropriate antidiuretic hormone (SIADH) is a condition in which the body produces too much anti-diuretic hormone. The condition causes the affected person to retain fluid. This causes low levels of sodium, which leads to many of the symptoms of SIADH, such as changes in level of consciousness and mental status. b. Hyperkalemia SIADH causes dilution of the blood, therefore increased serum potassium would not be seen. c. Hypocalcemia Low calcium levels are not the defining electrolyte imbalance seen in SIADH. d. Hypermagnesemia SIADH causes dilution of the blood, therefore increased serum magnesium would not be seen.

A 79-year-old client with Cushing's disease has developed some cognitive effects that are impacting his ability to care for himself. Which cognitive effects are most likely to develop in a client with Cushing's disease? a. Memory loss b. Coma c. Seizures d. Aggression

a. Memory loss Cushing's disease occurs when the pituitary gland produces excess amounts of adrenocorticotropic hormone. The client can experience changes in body structure, as well as changes in skin, muscles, and cognition. One of the most common cognitive effects associated with Cushing's disease over time is memory loss. b. Coma Coma is not commonly associated with Cushing's syndrome. c. Seizures Seizures are not commonly associated with Cushing's syndrome. d. Aggression Aggression is not a cognitive symptoms commonly seen in Cushing's syndrome clients.

A client is newly diagnosed with Addison's disease. The nurse understands that this condition includes a decrease of which of the following hormones? Select all that apply. a. Mineralcorticoids b. Testosterone c. Insulin d. Androgen e. Glucocorticoids

a. Mineralcorticoids These hormones are secreted by the adrenal cortex, & are deficient in Addison's disease. d. Androgen This is a hormone also secreted by the adrenal cortex. e. Glucocorticoids Glucocorticoids are secreted by the adrenal cortex. b. Testosterone Testosterone is secreted mainly by the gonads. A small amount of testosterone is secreted by the adrenal cortex, but deficiency in adrenal cortex hormones doesn't produce a deficiency in testosterone. c. Insulin Insulin is secreted in the pancreas

Indications for suctioning include: (SATA) a. coughing b. sneezing c. secretions in the airway d. respiratory distress e. presence of rales on auscultation f. decreased peak airway pressures on the ventilator g. increasing oxygenation saturation.

a. coughing c. secretions in the airway d. respiratory distress Indications for suctioning include: coughing, secretions in the airway, respiratory distress, presence of rhonchi on auscultation, increased peak airway pressures on the ventilator, and decreasing oxygenation saturation.

Your patient is on a mechanical ventilator, their FIO2 is 65 and they are experiencing chest pain. What is happening to them? a. pneumothorax b. MI c. oxygen toxicity d. PE

c. oxygen toxicity Patient's FIO2 >50 and is experiencing substernal chest pain, they probably have oxygen toxicity. High Risk: mechanical ventilation patients

A nurse suspects a client has diabetes insipidus. What are the priority interventions? Select all that apply. a. Monitor for hypernatremia b. Monitor strict I&O c. Monitor urine specific gravity d. Monitor neuro status e. Monitor for hyponatremia

a. Monitor for hypernatremia Due to excessive loss of water, the client's blood will become concentrated, making the sodium level go UP. Monitoring for hypernatremia is a priority. b. Monitor strict I&O Clients with diabetes insipidus lose large amounts of dilute urine, monitoring strict I&O measurements is a priority to know the client's fluid status. c. Monitor urine specific gravity Due to insufficient ADH, the body dumps large amounts of dilute urine. Monitoring urine specific gravity helps to monitor the dilution and/or concentration of the urine d. Monitor neuro status Diabetes insipidus causes a massive loss of water via the urinary tract due to insufficient secretion of ADH. This leads to cellular dehydration and hypernatremia. Both of these things can cause significant neurological changes, including confusion and seizures. Monitoring neuro status is a priority. e. Monitor for hyponatremia Due to excessive loss of water, the client's blood will become concentrated, making the sodium level go UP, not down. The nurse should be monitoring for hypernatremia, not hyponatremia.

This problem is a rare or congenital disorder, the kidney becomes unresponsive to the action of ADH. Vasopressin receptors do not work. Some medications can cause Nephrogenic DI such as Long-term of Lithium (Bi-Polar Disorders). Is it: a. Nephrogenic DI b. Central DI (neurogenic)

a. Nephrogenic DI

A client is admitted to the hospital with primary adrenal insufficiency. Which of the following drugs does the nurse anticipate giving for this condition? Select all that apply. a. Prednisone b. Prednisolone c. Dexamethasone d. Vasopressin e. Growth hormone

a. Prednisone Primary adrenal insufficiency symptoms are due to a hyposecretion of adrenal cortex hormones which are primarily glucocorticoids. These include dexamethasone, hydrocortisone, methylprednisolone & prednisone. b. Prednisolone Prednisolone is given to treat primary adrenal insufficiency. c. Dexamethasone Dexamethasone is given to treat primary adrenal insufficiency. d. Vasopressin There is not a deficiency of vasopressin in adrenal insufficiency. This is not a deficiency of vasopressin in adrenal insufficiency. e. Growth hormone There is not a deficiency of growth hormone in adrenal insufficiency.

A 47-year-old client has been brought to the emergency department after falling from a roof. He has absent breath sounds on his right side, crepitus, and sharp chest pain with tracheal deviation to the left. Which of the following nursing interventions is appropriate? a. Prepare client for chest tube placement b. Immediately place the client in Trendelenburg position c. Instruct the client in the proper use of a peak flow meter d. Instruct the client to self splint the chest

a. Prepare client for chest tube placement This client has the assessment findings of a pneumothorax. This occurs when the client's intrapleural space is compromised, either from a blunt chest injury or an opening in the chest wall. Intrathoracic pressure rises, and the affected lung collapses. For this condition, the nurse will administer oxygen, place the client in Fowler's position, and prepare for chest tube placement. b. Immediately place the client in Trendelenburg position The client with a pneumothorax has difficulty breathing due to a reduced ability to expand the lung. Placing them in Trendelenburg position would make breathing even more difficult for this client. c. Instruct the client in the proper use of a peak flow meter While the peak flow meter is useful for monitoring the status of asthma, it is not a useful intervention when caring for a client with a pneumothorax in the emergency department. d. Instruct the client to self splint the chest Splinting the chest causes some restriction with lung expansion. The client already has difficulty breathing and therefore would not benefit from splinting the chest.

What is your priority management for patients with HHS? SATA a. Rapid rehydration b. Slowly dehydrate c. insulin replacement d. withhold insulin and food

a. Rapid rehydration c. Replace insulin Priority Management →Rapid Rehydration, Insulin Replacement, correct electrolyte →→0.9% of Sodium Chloride (isotonic)- 1L/hr (monitor electrolytes). →Replace Insulin →→Prevent hypoglycemia with Dextrose & 0.45% of Sodium Chloride (Hypotonic) 150-250mL/hr once →BGL decreased to 300mg/dL →Correct electrolyte Imbalances, especially Potassium

This patient is presenting with a low urinary output, high levels of ADH, hyponatremia, they are are over hydrated, and retaining too much fluid. They also have an excessive sense of thirst. What do you suspect that that they have? a. SIADH b. DI c. DKA d. HHS

a. SIADH

What are priority actions for a patient experiencing DI? SATA a. Stop any meds that induce ADH suppression b. Start meds to induce ADH suppression c. Give Vasopressin d. Give ADH analog (desmopressin/DDVAP) intranasally e. Monitor I & Os f. Monitor Vitals g. Give Hypotonic 0.45% NS

a. Stop any meds that induce ADH suppression c. Give Vasopressin d. Give ADH analog (desmopressin/DDVAP) intranasally e. Monitor I & Os f. Monitor Vitals g. Give Hypotonic 0.45% NS Priority Actions Make sure to stop any medications that are inducing ADH suppression/resistance. Stop medications for 8 hours prior to labs. HYPOTONIC 0.45% NS Monitor vitals Urinary catheter→ I&Os Kidney function Monitor for Overhydration ADH (Vasopressin) or ADH Analog (Desmopressin/DDVAP) → Intra nasal spray

Which supports the diagnosis of diabetes insipidus? SATA a. hyperosmolality b. serum sodium 143mEq/L c. urine specific gravity of 1.032 d. excessive thirst e. BP 80/62 mmHG

a. hyperosmolality Correct - the osmolarity of the blood is high (hyperosmolality) in DI. This is because fluids are released excessively through the kidneys due to the lack of ADH b. serum sodium 143mEq/L Wrong - Serum sodium would be elevated , not normal (135-145). The serum sodium level is elevated due to the decrease of fluid in the blood stream. c. urine specific gravity of 1.032 Wrong - In DI, the urine specific gravity is low or <1.005. The level in the answer is within normal range. d. excessive thirst Correct - excessive thirst with excessive, frequent urination are major symptoms of DI. This is due to the lack of ADH in the body. e. BP 80/62 mmHG Correct - Hypotension is a consequence of decreased fluid in the blood. The patient is at risk for hypovolemic shock. All of this is due to a lack of ADH in the body.

Complications associated with suctioning include: SATA a. hypoxemia b. atelectasis c. bronchospasms d. arrhythmias e. decreased intracranial pressure f. airway trauma

a. hypoxemia b. atelectasis c. bronchospasms f. airway trauma Complications associated with suctioning include hypoxemia, atelectasis, bronchospasms, dysrhythmias, increased intracranial pressure, and airway trauma

What is capnography used for? a. measurement of exhaled CO2 b. measurement of inhaled O2 c. Graphing of ABGs d. Graphing of air in dead space

a. measurement of exhaled CO2 End-tidal Co2 monitoring, prioritization, when and why End-tidal Co2 monitoring or Capnography ▶︎ Measurement of exhaled CO2. → Mainstream → Side stream (also used in nonintubated pts) → Proximal diverting → Microstream (also used in nonintubated pts)

With invasive mechanical ventilation, what are you looking at for the patient assessment? SATA a. placement of the ETT or Trach tube b. Pulse Oximetry c. Capnography d. ABG values e. PFT f. Vital capacity

a. placement of the ETT or Trach tube b. Pulse Oximetry c. Capnography d. ABG values e. PFT f. Vital capacity Patient Assessment Pulmonary system, placement of the ETT or tracheostomy tube, and observation for subcutaneous emphysema and dyssynchrony with the ventilator. Bedside evaluation of vital capacity, minute ventilation, ABG values, and other pulmonary function tests may be warranted, according to the patient's condition. The use of pulse oximetry can facilitate continuous, noninvasive assessment of oxygenation. The use of capnography may facilitate continuous noninvasive assessment of ventilation. Static and dynamic compliance should also be monitored to assess for changes in lung compliance

The areas in the lungs where there is no gas exchange is known as: a. pulmonary dead space b. work of breathing c. respiration d. free air

a. pulmonary dead space What is Pulmonary Dead Space? The areas in the lungs are ventilated but there is no gas exchange.

The problem where there is a limit on chest wall movement is: a. restrictive b. obstructive

a. restrictive

A patient walks into the ER. They have abdominal pain, Kussmaul respirations, an altered LOC, polydipsia, polyphagia, polyuria, vomiting, thready pulse, acetone breath, and their pulse is thready and tachycardic. What is a priority action take when you realize what is happening? SATA a. reverse dehydration b. replace electrolytes c. replace insulin d. give insulin e. give a diuretic

a. reverse dehydration b. replace electrolytes c. replace insulin The patient has DKA. They have lost 5-10% of fluid body weight. They should be kept NPO. We want their blood sugar to drop to a level of 50-70 mg/dL/hr.

The movement of air in & out of the lungs is: a. ventilation b. respiration c. pleural friction rub d. pulmonary dead space

a. ventilation

The nurse is working with a client who has been diagnosed with Cushing's syndrome. The nurse has provided teaching about the disease process and management. Which of the following statements by the client demonstrates a need for additional teaching? a. "If we don't treat this, it can become life-threatening" b. "I will need to take levothyroxine for the rest of my life" c. "You are going to monitor my labs closely because electrolyte disturbances are common" d. "I am secreting too much cortisol, which is what's causing my symptoms"

b. "I will need to take levothyroxine for the rest of my life" Taking a thyroid medication is necessary for persons with hypothyroidism rather than hyperthyroidism. Taking this drug would cause the condition to worsen. a. "If we don't treat this, it can become life-threatening" If left untreated, Cushing's syndrome can progress to heart failure, as well as profound glucose abnormalities and electrolyte imbalances. c. "You are going to monitor my labs closely because electrolyte disturbances are common" Electrolyte disturbances seen with Cushing's syndrome include hypokalemia, hypocalcemia. and hypernatremia. d. "I am secreting too much cortisol, which is what's causing my symptoms" This is a TRUE statement in regards to Cushing's syndrome.

The nurse walks into a client's room and notices that their skin is a dark bronze color. The nurse knows this could indicate which of the following diseases? a. Huntington's disease b. Addison's disease c. Bell's palsy d. Alcoholism

b. Addison's disease Clients with Addison's Disease can develop bronze-colored skin a. Huntington's disease Huntington's Disease is characterized by involuntary movements, but not a change in skin color. C. Bell's Palsy This condition is characterized by muscle weakness to one side of the face, but does not involve a change in skin color. d. Alcoholism A client with alcoholism can develop jaundice, which is characterized by yellowing of the skin and eyes. The color is yellow, however, and not bronze.

The nurse assesses a client and notices that the lungs have coarse crackles and the client is struggling to breath, and the client's legs are edematous. The nurse should implement which of the following orders first? a. Call the healthcare provider b. Check vital signs c. Give PRN hydralazine 25 mg IV d. Palpate the client's pulses in the legs

b. Check vital signs The nurse should check the client's vital signs first to determine if the client needs oxygen or any other treatment. The vital signs will also be needed to report to the healthcare provider. a. Call the healthcare provider The nurse should call the healthcare provider after a set of vital signs are taken. Vitals are the priority. c. Give PRN hydralazine 25 mg IV There is no indication to give hydralazine to this client. The blood pressure was not taken to determine if it is high and hydralazine is a blood pressure medication. d. Palpate the client's pulses in the legs The nurse should check the client's vital signs. Palpating the pulses would not help in this situation.

A nurse is caring for a client who has been diagnosed with Cushing's syndrome. The client is at risk of impaired skin integrity related to skin dryness and edema. Which of the following goals would be most appropriate for this client? a. Client will demonstrate a knowledge of the layers of skin and underlying tissues b. Client will support skin integrity by applying healing ointments and protective measures c. Client's pain will be managed using pharmacologic medications for the next 12 hours d. Client will have improved body image before discharge from the hospital as evidenced by verbalizing acceptance of skin appearance

b. Client will support skin integrity by applying healing ointments and protective measures A client with endocrine dysfunction such as Cushing syndrome may be at greater risk of skin changes, including skin breakdown. The nurse should teach the client how to care for the skin, which may involve applying protective ointments and taking measures to keep the skin intact. a. Client will demonstrate a knowledge of the layers of skin and underlying tissues This detailed knowledge is not necessary in order for the client to be able to properly care for skin. c. Client's pain will be managed using pharmacologic medications for the next 12 hours Obesity, skin changes, and fatigue are some common symptoms of Cushing syndrome, but pain is not. d. Client will have improved body image before discharge from the hospital as evidenced by verbalizing acceptance of skin appearance Body image issues related to Cushing syndrome are usually due to body shape rather than skin appearance. More importantly, the nurse should teach the client proper skin care to prevent breakdown due to changes from the syndrome.

This patient is presenting with high urinary output, low levels of ADH, hypernatremia, they are dehydrated and are losing too much fluid. They also have an excessive sense of thirst. What do you suspect that that they have? a. SIADH b. DI c. DKA d. HHS

b. DI

The nurse is caring for a client with Cushing's syndrome and reviews the client's most recent CMP. Which of the following electrolyte imbalances is an expected finding for this client? Select all that apply. a. Hyponatremia b. Hypokalemia c. Hypochloremia d. Hyperglycemia e. Hypocalcemia

b. Hypokalemia Since Cushing's syndrome includes excess aldosterone levels, which cause hypernatremia. When sodium is high in the body, the kidneys excrete more potassium, so hypokalemia is an expected finding. d. Hyperglycemia The excess cortisol presence in Cushing's syndrome leads to hyperglycemia, so this is an expected finding. e. Hypocalcemia Low calcium levels are expected in the client with Cushing's syndrome. a. Hyponatremia A client with Cushing's syndrome is not excreting sodium (Na) normally, causing a build-up of Na in the blood. Therefore hypernatremia is an expected finding, not hyponatremia. c. Hypochloremia Chloride is more likely to be high than low. Hypochloremia is not an expected finding in the client with Cushing's syndrome.

A client with Addison's disease is deficient in aldosterone. Which of the following are symptoms of this condition? Select all that apply. a. Bradypnea b. Hypotension c. Dehydration d. Hyperkalemia e. Hyponatremia

b. Hypotension A deficiency in aldosterone leads to diuresis, which decreases blood volume and BP c. Dehydration Aldosterone stimulates the reabsorption of sodium & potassium. Without it, these electrolytes are excreted from the body along with water which leads to dehydration d. Hyperkalemia Aldosterone causes potassium to be reabsorbed in the kidneys, so a lack of this hormone leads to hyperkalemia e. Hyponatremia Aldosterone causes sodium to be kidneys, so a lack of this hormone leads to hyponatremia a. Bradypnea Bradypnea is not a side effect of aldosterone deficiency

A client is experiencing an adrenal crisis due to Addison's Disease. Which of the following would NOT be a priority nursing intervention for this client? a. Monitor for fluid volume deficit b. Monitor for hypocalcemia c. Monitor for hyponatremia d. Monitor for hypoglycemia

b. Monitor for hypocalcemia Clients in adrenal crisis (severe adrenal insufficiency) are more likely to experience hypercalcemia, NOT hypocalcemia, due to less excretion by the kidneys and calcium being pushed out of the cells. a. Monitor for fluid volume deficit These clients are at risk for volume deficit because of severe vomiting and diarrhea. c. Monitor for hyponatremia In adrenal crisis, it is difficult to excrete free water, meaning the blood becomes diluted - causing hyponatremia. d. Monitor for hypoglycemia Adrenal crisis causes hypoglycemia due to the low levels of corticosteroids, especially cortisol.

Nursing priorities for the patient with an artificial airway focus on: SATA a. providing a dry environment b. providing humidification c. maintaining cuff management d. suctioning e. making sure not overoxygenate while suctioning f. establishing communication g. providing nasal hygiene

b. providing humidification c. maintaining cuff management d. suctioning f. establishing communication Nursing priorities for the patient with an artificial airway focus on 1) providing humidification 2) maintaining cuff management 3) suctioning (hyperoxygenate before & after) 4) establishing a method of communication 5) providing oral hygiene

Signs & Symptoms Fatigue, weakness, Increased sensitivity to the cold, Constipation, Dry skin, brittle hair & nails, weight gain, deepened voice, depression, hyperlipidemia. Respiratory Depression, Cardiogenic Shock, Hypothermia, Coma, decreased LOC Somnolence, decrease mental acuity GFR and urine specific gravity and urine osmolality are decreased. What is this condition? a. Addison's b. Myxedema Coma c. Nephrogenic DI f. HHS

b. Myxedema Coma Patho→ AMIODARONE (hypo or hyperthyroidism) Severe hypothyroidism. Severe deficiency of Thyroid Hormone producing hypothyroidism. There is a spectrum of hypothyroidism. Determined by labs and clinical symptoms that range anywhere from Mild Hypothyroidism to Severe Hypothyroidism. Hallmark features of this condition Precipting illness, Altered mental status Hypothermia, Bradycardia Abnormal Thyroid Blood Level: Increased TSH (>30), low T3 & T4 Slow metabolic rate Reduced O2 concentration. Cells are unable to maintain the process of metabolism. Reduce protein synthesis Due to decreased amino production and decrease tissue repair (decrease thyroid hormone). Carbs & Fat Metabolism Decreased & Gluconeogenesis can not supply more glucose, because carbs & fat metabolism is suppressed. Cholesterol Collects, increases in the bloodstream. Hypothermia occurs & deposits of Hyaluronic Acid accumulate in the interstitial spaces.- FULL FACE

Your preceptor is explaining that oral care for and endotracheal tube should consist of 1) brushing the patient's teeth with a soft toothbrush to reduce plaque 2) brushing the patient's tongue and gums with a foam swab to stimulate the tissue 3) giving the patient mouthwash 4) performing shallow oropharyngeal suctioning to remove any secretions that have pooled above the patient's cuff. Is she correct? a. Yes b. No

b. No Oral care should consist of: 1. brushing the patient's teeth with a soft toothbrush to reduce plaque 2. brushing the patient's tongue and gums with a foam swab to stimulate the tissue 3. performing deep oropharyngeal suctioning to remove any secretions that have pooled above the patient's cuff

A client is admitted to the emergency room and the nurse is performing an assessment and notes there to be decreased breath sounds to one side of the chest. The nurse knows this is indicative of which of the following? a. Lower abdominal injury b. Pneumothorax c. Tracheobronchial injury d. Pericardial tamonade

b. Pneumothorax As air fills the thoracic cavity, it causes compression of the lung on the affected side causing diminished lung sounds. a. Lower abdominal injury This would not affect the lung. c. Tracheobronchial injury While the escape of air might occur, the change in lung sounds would likely be bilateral. d. Pericardial tamponade This should not have an effect on lung sounds.

A nurse is preparing to start an IV in a client's non-dominant extremity but notes that this arm is edematous. Which of the following are appropriate actions for the nurse to take? Select all that apply. a. Select a distal site in the edematous extremity for cannulation b. Select any site on the non-edematous extremity for cannulation c. Contact the provider to clarify that an IV is necessary d. Use a transilluminator on the skin to find a proximal vein on the edematous extremity e. Utilize the edematous extremity only if it is non-pitting edema

b. Select any site on the non-edematous extremity for cannulation When starting an IV in a client, using an edematous extremity is contraindicated. While it is good practice to cannulate in a non-dominant arm for the client's convenience, it is more important to avoid an area of the body with an abnormal presentation. Test-taking tip: When answering SATA questions, remember that there may only be one right answer. a. Select a distal site in the edematous extremity for cannulation The nurse should avoid this side completely when selecting an IV site. c. Contact the provider to clarify that an IV is necessary This issue can be resolved by the nurse's good clinical judgement. It does not need to be escalated to the provider. d. Use a transilluminator on the skin to find a proximal vein on the edematous extremity The nurse should avoid this side completely when selecting an IV site. e. Utilize the edematous extremity only if it is non-pitting edema An edematous arm should not be used for cannulation.

A client with diabetes insipidus must start taking vasopressin. Which information from the nurse is correct when providing teaching about this medication? a. Vasopressin is taken as an oral tablet or in syrup form b. The physician may order a routine ECG while the client is taking vasopressin c. The client will need to increase his or her fluid intake while on this medication d. Vasopressin can cause severe hypomagnesemia as a potential side effect

b. The physician may order a routine ECG while the client is taking vasopressin Vasopressin is a synthetic form of an anti-diuretic hormone that works by helping the body reabsorb water through the kidneys and by improving blood pressure. When a client must take this medication, the nurse should let the client know that some tests are required while the client is taking the drug. For example, the client may need routine ECG testing to monitor heart function while on this drug, due to the risk of arrhythmias. a. Vasopressin is taken as an oral tablet or in syrup form This medication is available as a tablet or IV form, but not a syrup. c. The client will need to increase his or her fluid intake while on this medication Too much fluid intake while on vasopressin can lead to serious complications. d. Vasopressin can cause severe hypomagnesemia as a potential side effect Hypomagnesemia is not associated with vasopressin use.

What do beta cells secrete? a. pancreatic polypeptide b. insulin c. glucagon d. somatostatin

b. insulin Insulin (responsible for storage of carbohydrates, protein, fat, helps transport potassium into cells too, helps lower blood glucose).

The problem where there is an impediment of normal airflow such as in bronchitis, emphysema, asthma, COPD is: a. restrictive b. obstructive

b. obstructive

What may affect the rate of diffusion? SATA a. Pleural friction rub b. thickness of the alveolar-capillary membrane c. respiration d. surface area of the membrane of the alveolar e. higher altitudes

b. thickness of the alveolar-capillary membrane d. surface area of the membrane of the alveolar e. higher altitudes What else may affect the rate of diffusion Thickness of the Alveolar-Capillary Membrane→ Pulmonary Edema, Fibrosis, Emphysema Surface Area of the Membrane of the Alveolar→ if the surface area is decreased → Pulmonary embolism, Fibrosis, Emphysema. Higher altitudes→ less atmospheric oxygen, more Co2 in the body. Difficulty getting oxygen in.

The amount of work that must be performed to overcome the Elastic & Resistance properties of the lungs is called: a. ventilation b. work of breathing c. respiration d. pleural friction rub

b. work of breathing

A calculator of the difference between measurable extracellular plasma cations (Na+ & K+) and the measurable anions (Cl- & HCO3-) is called? a. the Ketotic cycle b. Hyperosmotic filtration c. Anion Gap d. Nephrogenic filtration

c. Anion Gap A calculator of the difference between measurable extracellular plasma cations (Na+ & K+) and the measurable anions (Cl- & HCO3-) is the anion gap

The nurse is performing an admission assessment on a client and notes that the client has a moon-shaped face. The nurse understands that this could indicate which of the following? a. Huntington's disease b. Addison's disease c. Cushing's syndrome d. Down's syndrome

c. Cushing's syndrome A client with Cushing's syndrome will likely have a moon-shaped face, due to redistribution of fat from the disease process. a. Huntington's disease This disease is characterized by involuntary movements most noted in the face, but the client with Huntington's disease will not have a moon-shaped face. b. Addison's disease A client with Addison's disease may have areas of the skin that are darkened, but a moon-shaped face is not characteristic of this disease. d. Down's syndrome Down's syndrome is characterized by poor muscle tone and a flattened appearance to the face, but not a moon-shaped face.

The floor nurse is reviewing lab results for a client with syndrome of inappropriate antidiuretic hormone (SIADH) and notes a sodium level of 132 mEq/L. The nurse continues to monitor the client closely for which of the following abnormal signs/symptoms? a. Complaints of excessive thirst b. Palpitations in the chest c. Decreased level of consciousness d. Bilateral pupil constriction to light

c. Decreased level of consciousness A client with severe hyponatremia will demonstrate symptoms which include weakness and a decreased level of consciousness. This indicates that the client may have cerebral edema, and need emergent intervention. a. Complaints of excessive thirst Excessive thirst is a sign of hypernatremia. The client with SIADH is not at risk of developing hypernatremia. b. Palpitations in the chest Chest palpitations are a sign of abnormal potassium levels, not sodium levels. d. Bilateral pupil constriction to light Bilateral pupil constriction is a normal finding, and is not indicative of symptomatic hyponatremia.

Upon assessment, your patient has profound dehydration. When you inspect their mouth, you see longitudinal wrinkles in their tongue and decreased salivation. Their skin is dry & tenting. They are tachycardic and have a decreased venous pressure. What do you suspect is wrong with them? a. DKA b. SIADH c. HHS d. DI

c. HHS Assessment Profound dehydration Longitudinal wrinkles in the tongue Decrease salivation Decrease CVP (central venous pressure) Tachycardia Dry skin, flaky, skin tenting. BGL >1,500= coma

A client who has suffered a traumatic brain injury (TBI) has developed diabetes insipidus. A home health nurse is seeing the client in his home to help him manage his care at home. Which of the following teaching points would the nurse offer to help prevent injury in this client? a. Encourage the client to wear socks and extra blankets when sleeping at night b. Tell the client to reduce fluid intake and avoid drinks that contain caffeine c. Have the client ensure easy access to the bathroom or bedside commode d. Reinforce keeping a fan on in the room next to the bed while sleeping

c. Have the client ensure easy access to the bathroom or bedside commode A client with diabetes insipidus and a history of TBI may be at higher risk of injury, particularly if he must get up to use the bathroom frequently. The nurse should ensure that the client knows to keep the home organized and free from clutter and to keep a clear walkway to the bathroom or the commode so that the client will not be injured when he gets up to use the bathroom a. Encourage the client to wear socks and extra blankets when sleeping at night Socks increase the chance of a slip and fall. Extra blankets are difficult to manage at night when a person is in a hurry to get to a toilet. These actions would decrease safety rather than make the area safer. b. Tell the client to reduce fluid intake and avoid drinks that contain caffeine Diabetes insipidus results in excessive excretion of water in the form of dilute urine. It is a regulation problem related to the pituitary gland, so reducing fluid intake or avoiding caffeine will not alleviate the problem. d. Reinforce keeping a fan on in the room next to the bed while sleeping Adding a fan by the bed is an additional tripping hazard for the client. This decreases safety rather than making the area safer.

Problems like PE, Pneumonia, Pleurisy, Pulmonary Edema have the creaky, lethargy, dry, sound, coarse sound which is caused by irritated Pleural Surfaces rubbing together and is "Painful", commonly in the lower anterior lateral chest area is known as: a. pulmonary dead space b. work of breathing c. pleural friction rub d. free air

c. pleural friction rub Pleural Friction Rub Creaky, lethargy, dry, sound, coarse sound. Caused by Irritated Pleural Surfaces rubbing together "Painful", commonly in the lower anterior lateral chest area. PE, Pneumonia, Pleurisy, Pulmonary Edema

Gas exchange at the alveolar capillary membrane is: a. ventilation b. work of breathing c. respiration d. pleural friction rub

c. respiration

A client with Cushing's syndrome has become more withdrawn from friends and relatives because of changes in appearance. Upon admission to the healthcare center, the nurse gives the client a nursing diagnosis of Social Isolation related to discomfort with others and feelings of rejection by other people. Which of the following nursing interventions is most appropriate in this situation? a. Help the client to monitor her diet to include more sources of carbohydrates from whole grains and vegetables b. Teach the client to verbalize I feel that you are rejecting me when in social circles c. Help the client to consider what small changes she could make to integrate herself into the community and make new friends d. Assist the client with finding a church that she can join

c. Help the client to consider what small changes she could make to integrate herself into the community and make new friends Social isolation can be seen among some clients who struggle with their appearance because of changes due to a disease process, including endocrine dysfunction. Social isolation leads to loneliness and studies show that clients usually feel increasing depression because of lack of social interaction. The nurse may help the client in this situation to make small changes in her lifestyle that could slowly integrate her back into the community where she could meet new people and expand her network of friends. a. Help the client to monitor her diet to include more sources of carbohydrates from whole grains and vegetables This is not related to the client's problem of social isolation. b. Teach the client to verbalize I feel that you are rejecting me when in social circles Using "I feel" statements is useful between two people, but is not intended for use in a group setting. d. Assist the client with finding a church that she can join Although a church is a potential place for the client to find social community, the nurse should tailor options based on the client's preferences, which may not necessarily include a church.

A nurse needs to assess posterior lung sounds in a client. In which position would it be most appropriate to place this client? a. Semi-Fowler's b. Dorsal Recumbent c. High Fowler's d. Sim's Position

c. High Fowler's To assess the back and listen to posterior lung sounds, the nurse should place the client in the high Fowler's position. In this position, the client is sitting up with the head of the bed at a 90-degree angle. The high Fowler's position is used for performing an assessment that would require the client to sit up, such as the face and head, chest, and back. a. Semi-Fowler's The most appropriate position is High Fowler's position b. Dorsal Recumbent The most appropriate position is High Fowler's position d. Sim's Position The most appropriate position is High Fowler's position

The nurse is caring for a client with Cushing syndrome. The nurse knows to perform which daily activity? a. Linens need to be constantly changed, so make sure they are stocked b. Medications need to be exactly on time c. Make sure the scale is near the client's room d. Make sure the client is near the nurse's station

c. Make sure the scale is near the client's room Clients with Cushing syndrome are at risk for excessive fluid retention which can cause cardiac stress and hypokalemia. The nurse should anticipate daily weights as one way to monitor the client's fluid retention status. a. Linens need to be constantly changed, so make sure they are stocked Fluid retention is of primary concern to the nurse. b. Medications need to be exactly on time Fluid retention is of primary concern to the nurse. d. Make sure the client is near the nurse's station Fluid retention is of primary concern to the nurse.

A nurse is caring for a client with pneumonia who has just had their endotracheal tube removed. Which of the following breath sounds would be the MOST concerning at this time? a. Crackles b. Rhonchi c. Stridor d. Wheezing

c. Stridor Hearing Stridor is always an urgent situation, but especially after extubation. This could indicate an obstructed or narrowed upper airway, possibly caused by trauma and swelling from the extubation. This requires immediate intervention - often the client will need to be re-intubated. a. Crackles While this is important to note, it would not be the most concerning after extubation. Stridor is an emergency. b. Rhonchi The client has pneumonia, which means it is expected that they may have some rhonchi due to mucus buildup in their smaller airways. This is not the most concerning finding at this time. d. Wheezing Although wheezing, especially if it is a new sign, is concerning, stridor is always more concerning because it indicates narrowing of the upper airways - this is a medical emergency.

A nurse is caring for a client who is 68-years-old and has been diagnosed with chronic lung disease. The client already has a diagnosis of heart failure and has been in the hospital for breathing difficulties. The nurse wants to gather an interdisciplinary team to talk about this client's care. In this situation, the most likely reason for meeting with an interdisciplinary team is which of the following? a. To help the nurse feel a sense of professional satisfaction b. To motivate other staff members to focus on their jobs c. To shift the focus from acute care to ongoing care d. To make the best use of the client's time in the hospital

c. To shift the focus from acute care to ongoing care Part of the work of an interdisciplinary team is to coordinate efforts for care when the client has a chronic illness that will need to be managed after receiving acute care in the hospital. The focus of this team's interventions should be to determine the best plan of action to prepare the client for ongoing management of heart failure. a. To help the nurse feel a sense of professional satisfaction The reason for assembly of this team is to facilitate a potential change in approach to care from acute to ongoing management. b. To motivate other staff members to focus on their jobs The reason for assembly of this team is to facilitate a potential change in approach to care from acute to ongoing management. d. To make the best use of the client's time in the hospital The reason for assembly of this team is to facilitate a potential change in approach to care from acute to ongoing management.

You are assessing a patient and their blood glucose level is >1500. What do you think the patient is looking like? a. they are fine b. yawning c. coma d.. agitated-ready to leave the hospital

c. coma BGL >1,500= coma

What do alpha cells excrete? a. pancreatic polypeptide b. insulin c. glucagon d. somatostatin

c. glucagon Glucagon (released when sugar levels are low, released from the liver to raise blood glucose levels). This is done through Gluconeogenesis from non-carbohydrates (proteins & fat

A provider has prescribed hormone replacement therapy for a client who has Addison's disease. The nurse who is caring for this client understands the difference between Addison's disease and Cushing's syndrome as which of the following? a. Addison's is caused by hyperplasia of the adrenal gland while Cushing's is caused by pituitary enlargement b. Addison's requires treatment with lifetime hormone replacement therapy while Cushing's does not c. Addison's causes signs of masculinity in women while Cushing's causes atrophy of skin, tissues, and hair d. Addison's occurs as the result of decreased secretions of hormones while Cushing's occurs as a result of increased secretion

d. Addison's occurs as the result of decreased secretions of hormones while Cushing's occurs as a result of increased secretion Addison's disease & Cushing's Syndrome are 2 conditions that develop as a result of abnormal secretion of hormones. In the case of Addison's disease, the client doesn't secrete enough adrenocortical hormones , and the treatment is to ADD glucocrticoid or mineralcorticoid medications as prescribed. In Cushing's syndrome, the client secretes too much cortisol due to a variety of potential factors, including ACTH secreting tumors or a metabolic disorder. a. Addison's is caused by hyperplasia of the adrenal gland while Cushing's is caused by pituitary enlargement Cushing's is caused by the administration of glucocorticoids, or excess production of cortisol. Addison's is caused by the hyposecretion of adrenal cortex hormones. b. Addison's requires treatment with lifetime hormone replacement therapy while Cushing's does not Addison's requires lifelong glucocorticoid replacement, and clients with Cushing's who get an adrenalectomy will also require lifetime hormone replacement. c. Addison's causes signs of masculinity in women while Cushing's causes atrophy of skin, tissues, and hair Signs and symptoms of Addison's include weight loss, GI problems, lethargy and hyperpigmentation of the skin. Signs and symptoms of Cushing's include generalized weakness, truncal obesity, and masculine characteristics in women.

The client needs replacement of the hormones necessary for the regulation of fluid and electrolyte balance within the body. Which hormones will the nurse expect to replace? Select all that apply. a. Renin b. Angiotensin c. Cortisol d. Aldosterone e. Antidiuretic hormone (ADH)

d. Aldosterone Both ADH & aldosterone regulate the fluid & electrolyte balance through their action on the kidneys. Parathyroid hormone also regulates fluid & electrolyte balance. e. Antidiuretic hormone (ADH) Both ADH & aldosterone regulate the fluid & electrolyte balance through their action on the kidneys. Parathyroid hormone also regulates fluid & electrolyte balance. a. Renin Renin & angiotensin control BP, but not fluid & electrolyte balance. b. Angiotensin Renin & angiotensin control BP, but not fluid & electrolyte balance. c. Cortisol Cortisol is a hormone involved in the metabolism of macronutrients

An ambulance arrives at the emergency department with a client who has audible sucking noises on both inspiration and expiration and diminished breath sounds on one side. Which of the following procedures should the nurse anticipate? a. Humidified O2 b. Arterial blood gas draw c. Rapid fluid infusion d. Chest tube insertion

d. Chest tube insertion These signs and symptoms are consistent with an open pneumothorax. The client needs an occlusive dressing to stop airflow at the site of the sucking sound, and will require placement of a chest tube to reinflate the lung on the affected side. a. Humidified O2 The client will need supplemental oxygen, but not necessarily humidified oxygen. Preparing for chest tube placement is the more appropriate answer. b. Arterial blood gas draw While blood gas labs will give good clinical insight to the client's respiratory status, it is more important to stabilize the client by setting up for chest tube insertion. c. Rapid fluid infusion This client is not showing signs and symptoms of dehydration or sepsis, which would warrant rapid fluid infusion. Instead, the client must be stabilized by stopping the air leak in the affected lung using a chest tube.

You just received labs back on a patient. Sodium: 149 Serum Osmolality: 300 Urine osmolality: 205 Urine Specific Gravity: 1.010 What is the possible problem with this patient? a. DKA b. SIADH c. HHS d. DI

d. DI Labs Increased Sodium concentration: >145 Increased Serum Osmolality: >295 Urine Osmolality: <200 Urine specific gravity: decrease (1.005-1.025) ADH: normal 1-5, when serum ADH levels are severely depressed less than 0.5 the osmolality in urine falls <100. Urine output increases to 800-1000mL/hr.

Your patient has a decreased urine osmolality and a low urine specific gravity.Their family member said that they have been drinking so much water lately and having to pee all the time. They are here because they think she had a seizure today. What do you think is wrong with this patient? a. DKA b. SIADH c. HHS d. DI

d. DI Patho The purpose of ADH is to maintain normal serum osmolality and circulating volume. In central DI, free water is eliminated and urine osmolality & specific gravity decreases causing dilute urine. Sodium & Serum Osmolality increases in the blood. When serum osmolality increases to greater 290 mOsm. It triggers thirst sensors. The person drinks a lot of water to prevent dehydration and to return Serum Osmolality to a normal level. If the patient has a decreased LOC and unconscious. The polyuria leads to severe hypernatremia (dehydration) and decreases cerebral perfusion. Seizures can happen, loss of consciousness & death. As dehydration increases hypotension and hypovolemic shock occurs.

The patient presents to the hospital with a blood glucose level of 400, their pH is 7.1, HCO3 is 17. They have moderate-severe ketonemia & ketonuria. Their plasma osmolality is 300. What is do you suspect is wrong with this patient? a. HHS b. SIADH c. DI d. DKA

d. DKA Diabetic Ketoacidosis (DKA): Type I Diabetes (Insulin Dependent-does not produce Insulin) Dx Criteria→ Hyperglycemia BGL: >250mg/dL (alone, is not a definitive diagnosis) pH: <7.3 HCO3: <18mEq/L (severe metabolic acidosis) Moderate-Severe Ketonemia or Ketonuria Hyperglycemia plasma osmolality- 275-295 (greater than 295) Increased Osmolality: increased hemoconcentration, dehydration "hypertonic" Decreased Osmolality: decreased, hemodilution, volume overload "hypotonic" Chemistry panel-potassium can be normal or abnormal, low sodium (hyponatremia from N/V) which can cause Cerebral Edema.

Your patient comes into the ER with profound dehydration and changes in mental status. His blood glucose level is >600. He has a pH of 7.5, HCO3 of 19 and his serum osmolality is 320. There are no ketones present in his urine. Based upon this, what do you think the patient has? a. DKA b. DI c. SIADH d. HHS

d. HHS Hyperglycemic Hyperosmolar State- Type II Diabetes Dx Criteria → Extremely high levels of Plasma Glucose with resulting Elevation of Serum Osmolality causing Osmotic Diuresis. Profound dehydration and changes in mental status BGL: >600mg/dL pH: >7.3 HCO3: >18 mEq/dL Serum Osmolality > 320 Absent Ketones Signs & Symptoms Visual changes, Mental Status Changes, Hypovolemic Shock Older adults with cardiovascular comorbidities are at highest risk Triggered by pneumonia, UTI, stroke, MI, trauma, major surgery, stress.

A client has been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following is NOT a priority nursing intervention for this client? a. Flush NG tube with normal saline rather than sterile water b. Initiate seizure precautions c. Encourage increased dietary intake of sodium d. Increase fluid intake to at least 2L/day

d. Increase fluid intake to at least 2L/day SIADH causes extreme over-retention of water, therefore these clients should have a fluid restriction, not an increase. Typically these clients will be restricted to 500-1,000 mL per day to prevent further hemodilution. a. Flush NG tube with normal saline rather than sterile water Clients with SIADH should be on a free water restriction. They should not be drinking straight water, nor should their feeding tubes be flushed with water. Clients should consume juice, coffee, tea, soda, and tubes should be flushed with saline to prevent further water intoxication. b. Initiate seizure precautions SIADH can cause severe hyponatremia which puts the client at massive risk for seizures. Seizure precautions should be implemented right away. c. Encourage increased dietary intake of sodium SIADH causes significant hyponatremia, therefore clients should be encouraged to increase dietary intake and/or to take supplemental sodium replacements until the SIADH is resolved.

A client who had a bronchospasm was given ipratropium for treatment. The client asks the nurse how the medication works. Which of the following responses is accurate? a. It increases the production of cAMP, causing bronchodilation b. It causes coughing, which brings up sputum, opening up the bronchial tree c. It decreases inflammation in the bronchial tree d. It reverses the action of acetylcholine, causing smooth muscle relaxation

d. It reverses the action of acetylcholine, causing smooth muscle relaxation Ipratropium is an anticholinergic bronchodilator, which reverses the action of acetylcholine. This causes airway smooth muscle relaxation. a. It increases the production of cAMP, causing bronchodilation This is the mechanism of action of certain bronchodilators. However, ipratropium has an anticholinergic effect to dilate airway smooth muscle rather than affecting cAMP levels. b. It causes coughing, which brings up sputum, opening up the bronchial tree Coughing does not dilate the smooth muscle of the bronchial tree. c. It decreases inflammation in the bronchial tree Inhaled steroids can decrease inflammation in the bronchial tree, but this is not the action of ipratropium.

The nurse is caring for a client with diabetes insipidus and is preparing to administer a scheduled vasopressin injection. Which of the following is an anticipated outcome for a client with diabetes insipidus receiving this drug? a. Urine specific gravity of 1.001 b. Weight loss of 4 pounds in a week c. Oral intake of 4500 mL per day d. Urine output of 2000 cc/day

d. Urine output of 2000 cc/day When a client has diabetes insipidus (DI) they can have a urine output of up to 15,000 mL per day. With vasopressin injection, there should be less polyuria and polydipsia. A urine output of 2000 cc/day is a normal urine output, which indicates that the vasopressin is effective. a. Urine specific gravity of 1.001 A normal urine specific gravity is between 1.003 to 1.03. If the urine specific gravity is below this number, the urine is not concentrated enough which means the treatment is not working properly. b. Weight loss of 4 pounds in a week A client's response to vasopressin treatment cannot be measured in weight loss, because the client's weight may not change based on the severity of the DI. The client may be losing fluid at a rapid rate, but may also be taking in fluid to compensate for the loss, so their weight would not change. c. Oral intake of 4500 mL per day If the oral intake is 4500 cc/day, the diabetes insipidus is not being treated adequately because the client's intake of fluids is much higher than normal.

A patient presents with substernal chest pain that is exacerbated by deep breathing. A dry cough & tracheal irritation follow. Eventually, they start to show definite pleuritic pain on inhalation, followed by dyspnea. They may show changes such as nasal stuffiness, sore throat, eye and ear discomforts. Their CXR & PFT show no abnormalities until their symptoms are severe. What is wrong with this patient? a. pleural friction rub b. tension pneumothorax c. pulmonary embolism d. oxygen toxicity

d. oxygen toxicity OXYGEN TOXICITY A number of clinical manifestations are associated with oxygen toxicity. The first symptom is substernal chest pain that is exacerbated by deep breathing. A dry cough and tracheal irritation follow. Eventually, definite pleuritic pain occurs on inhalation, followed by dyspnea. Upper airway changes may include a sensation of nasal stuffiness, sore throat, and eye and ear discomforts. Chest radiographs and pulmonary function tests show no abnormalities until symptoms are severe. Complete, rapid reversal of these symptoms occurs as soon as normal oxygen concentrations are restored. Patient's FIO2 >50 and is experiencing substernal chest pain, they probably have oxygen toxicity. High Risk: mechanical ventilation patients

A nurse reads in a client's H&P that the client is deficient in a hormone that stimulates the adrenal cortex. What is an appropriate term for this hormone? a. Adrenotropin b. Adrenal cortectomy c. Corticosteroid hormone e. Adrenocorticotropic hormone

d.Adrenocorticotropic hormone "Adrenocortico-" refers to the adrenal cortex specifically. "tropic" refers to a hormone that stimulates a gland to release other hormones. a. Adrenotropin This term doesn't account for specifically stimulating the adrenal cortex b. Adrenal cortectomy "-ectomy" refers to surgical removal c. Corticosteroid hormone This is a type of steroid released by the adrenal cortex but isn't the hormone that causes stimulation of it.